Provider Demographics
NPI:1780046854
Name:GILLIAM, RUBY VANESSA LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:RUBY VANESSA
Middle Name:LEE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LEE
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1306 MOORES RUN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-9231
Mailing Address - Country:US
Mailing Address - Phone:513-314-4760
Mailing Address - Fax:
Practice Address - Street 1:1306 MOORES RUN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-9231
Practice Address - Country:US
Practice Address - Phone:513-314-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
OH280645163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No163WS0200XNursing Service ProvidersRegistered NurseSchool